A blood banker from Missouri reports that her institution is considering implementation of an electronic crossmatch, but concerns over lost revenue are pushing the process backwards. Her hospital uses Cerner as their Lab Information System. She wonders if any colleague has successfully implemented the electronic crossmatch procedure and begun billing for it.

In response to the above, the Editor suggests reading the earlier e-Network discussion on this issue.

The following comments have been received.

ADDENDA Nov. 7, 2002

1. The Editor has learned that use of the electronic crossmatch is common in some parts of Canada. Unfortunately, use of the electronic crossmatch does not seem to be as common in the United States, mainly because reimbursement for the electronic crossmatch is difficult. Colleagues in the US who have been successful in getting reimbursement are requested to please share their strategy.

ADDENDA Apr. 20, 2005

2. A colleague in the state of Georgia (whose 300-bed hospital transfuses 4000-6000 red cell units per year) reports that they have a C:T ratio of 1.4 and wastage of less than 2% of their blood stocks due to expired or discarded blood components. He reports that they are considering implementing an electronic crossmatch. He is aware that less than 3% of US hospitals currently employ an electronic crossmatch, possibly due to issues that need to be reconciled such as reimbursement (affected by DRGs), actual hospital collectible percentages, and the mix of inpatient/outpatient crossmatches done. He wonders if some of the hospitals that have implemented the electronic crossmatch would be willing to share their strategies used for justifying this conversion?

ADDENDA Apr. 22, 2005

3. William B. Lockwood, PhD, MD, (Chair of the AABB Coding & Reimbursement Committee - attribution used with permission), reports that a request for a reimbursement code for an electronic crossmatch was submitted to the AMA, and discussions indicate the possibility of a favorable ruling. If a CPT code is actually approved, the code might be available to use as soon as 2006. However, the allowed level of reimbursement is currently unknown.

4. A blood banker in the Southwest USA reports that the hospitals in their network use electronic crossmatching, and that a major benefit of using the electronic crossmatch includes the ability to work more efficiently with limited staffing. For example, when doing an electronic crossmatch, they do not need to perform an immediate spin crossmatch, which avoids "pulling" segments and making rbc suspensions. She reports that if a hospital uses productivity measures based on billable tests per FTE, an electronic crossmatch will not be beneficial, as the test is currently not reimbursable. She was encouraged to hear that Dr Lockwood (see addendum #3 above) thinks that a CPT code may be approved and available for use as soon as 2006, even if the allowed level of reimbursement is currently unknown.

ADDENDA Nov. 17, 2005

5. The Editor and Moderator reports that in the 2006 CPT Codes is a code for the Electronic (Computer) Crossmatch. The code number is 86923. This is the first time a CPT Code for the Electronic Crossmatch has been published.

ADDENDA Nov. 21, 2005

6. According to Suzanne H. Butch, MA, MT(ASCP)SBB at the Blood Bank & Transfusion Service at the University of Michigan (attribution used with permission) once the new CPT code for the electronic crossmatch (86923) becomes effective on 1-1-06, one can charge for an electronic crossmatch. However, it would not be permissible to charge for both an electronic crossmatch and any other type of crossmatch on the donor unit at the same time you are charging an electronic crossmatch. She acknowledges that if a facility plans to create a new code for an electronic crossmatch in its 'charge master', the facility should be able to include a charge for an electronic crossmatch, based on the actual costs for performing this service in the facility. Ms. Butch cautions that facilities that had been billing for an ABO or ABO/Rh retyping in lieu of the ability to charge for an electronic crossmatch may wish to consider discontinuing this 'retyping' charge as it may be considered a "quality control" test, and one cannot charge for quality control testing.

ADDENDA Jan. 24, 2006

7. Editor's note: In addition to the new CPT code for the computer crossmatch, there are a few other changes in the CPT codes that might be of interest to those involved in Transfusion Medicine. See attached pdf table derived from the CPT 2006 Professional Edition.

ADDENDA Feb. 13, 2006

8. A Technical Coordinator at a Blood Bank & Bone Marrow Transplant Lab in Illinois wonders if it would be appropriate to use CPT (Current Procedural Terminology) 86923 (Electronic Crossmatch) to bill for ABO crossmatching of organs for transplantation? He reports that their Blood Bank receives solid organs for transplantation (Liver, Kidney, Pancreas, Intestine and Heart) from UNOS (United Network for Organ Sharing) for ABO crossmatching/verification with the intended recipient before delivery to the operating room for transplantation. They use the computer system to verify the recipient’s ABO (ABO on a current sample) against the ABO on the label of all organs a required by UNOS. A transplant report form is generated in the blood bank for each organ as well a crossmatch tag that is affixed to the organ container with the crossmatch result as "ABO compatible" or "ABO Incompatible" for transplant.

Please submit comments to the e-Network Forum.

Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator